2019-20 SERVICE AGREEMENT

AN AGREEMENT BETWEEN:

Secretary, NSW Health

AND THE

Far West

Local Health District

FOR THE PERIOD

1 July 2019 – 30 June 2020

Date: .. ...... Signed: .....

NSW Health Service Agreement 2019/20 Principal Purpose

The principal purpose of the Service Agreement is to set out the service and performance expectations for the funding and other support provided to the Far West (the Organisation), to ensure the provision of equitable, safe, high quality, patient-centred healthcare services.

The Agreement articulates direction, responsibility and accountability across the NSW Health system for the delivery of NSW Government and NSW Health priorities. Additionally, it specifies the service delivery and performance requirements expected of the Organisation that will be monitored in line with the NSW Health Performance Framework.

Through execution of the Agreement, the Secretary agrees to provide the funding and other support to the Organisation as outlined in this Service Agreement.

Parties to the Agreement

The Organisation

The Hon Dr Andrew Refshauge Chair On behalf of the Far West Local Health District Board

Date: 22 July 2019 Signed: .

Mr Stephen Rodwell Chief Executive Far West Local Health District

Date: 22 July 2019 Signed.

NSW Health

Ms Elizabeth Koff Secretary NSW Health

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2

Contents

1. Objectives of the Service Agreement ............................................................................. 3

2. CORE Values ................................................................................................................ 3

3. Culture, Community and Workforce Engagement .......................................................... 3

4. Legislation, Governance and Performance Framework .................................................. 4

Schedule A: Strategies and Priorities ................................................................................... 7

Schedule B: Services and Networks .................................................................................. 11

Schedule C: Budget ........................................................................................................... 15

Schedule D: Purchased Volumes ....................................................................................... 20

Schedule E: Performance against Strategies and Objectives ............................................. 22

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1. Objectives of the Service Agreement

To articulate responsibilities and accountabilities across all NSW Health entities for the

delivery of NSW Government and NSW Health priorities.

To establish with Local Health Districts (Districts) and Speciality Health Networks

(Networks) a performance management and accountability system for the delivery of high

quality, effective health care services that promote, protect and maintain the health of the

community, and provide care and treatment to sick and injured people, taking into account

the particular needs of their diverse communities.

To develop formal and ongoing, effective partnerships with Aboriginal Community

Controlled Health Services ensuring all health plans and programs developed by Districts

and Networks include measurable objectives that reflect agreed Aboriginal health

priorities.

To promote accountability to Government and the community for service delivery and

funding.

2. CORE Values

Achieving the goals, directions and strategies for NSW Health requires clear and co-ordinated

prioritisation of work programs, and supportive leadership that exemplifies the CORE Values

of NSW Health:

Collaboration – we are committed to working collaboratively with each other to achieve the

best possible outcomes for our patients who are at the centre of everything we do. In

working collaboratively we acknowledge that every person working in the health system

plays a valuable role that contributes to achieving the best possible outcomes.

Openness – a commitment to openness in our communications builds confidence and

greater cooperation. We are committed to encouraging our patients, and all people who

work in the health system, to provide feedback that will help us provide better services.

Respect – we have respect for the abilities, knowledge, skills and achievements of all

people who work in the health system. We are also committed to providing health services

that acknowledge and respect the feelings, wishes and rights of our patients and their

carers.

Empowerment – in providing quality health care services we aim to ensure our patients

are able to make well informed and confident decisions about their care and treatment.

We further aim to create a sense of empowerment in the workplace for people to use their

knowledge, skills and experience to provide the best possible care to patients, their

families and carers.

3. Culture, Community and Workforce Engagement

The Organisation must ensure appropriate consultation and engagement with patients, carers

and communities in the design and delivery of health services. Impact Statements, including

Aboriginal Health Impact Statements, are to be considered and, where relevant, incorporated

into health policies. Consistent with the principles of accountability and stakeholder

consultation, the engagement of clinical staff in key decisions, such as resource allocation and

service planning, is crucial to the achievement of local priorities.

4

3.1 Engagement Surveys

The People Matter Employee Survey measures the experiences of individuals across the

NSW Health system in working with their team, managers and the organisation. The

results of the survey will be used to identify areas of both best practice and improvement

opportunities, to determine how change can be affected at an individual, organisational

and system level to improve workplace culture and practices.

The Junior Medical Officer Your Training and Wellbeing Matters Survey will monitor the

quality of supervision, education and training provided to junior medical officers and their

welfare and wellbeing. The survey will also identify areas of best practice and further

opportunities for improvement at an organisational and system level.

The Australian Medical Association, in conjunction with the Australian Salaried Medical

Officers Association, will undertake regular surveys of senior medical staff to assess

clinical participation and involvement in local decision making to deliver patient centred

care.

4. Legislation, Governance and Performance Framework

4.1 Legislation

The Health Services Act 1997 (the Act) provides a legislative framework for the public health

system, including setting out purposes and/or functions in relation to Local Health Districts (ss

8, 9, 10).

Under the Act, the Health Secretary’s functions include: the facilitation of the achievement and

maintenance of adequate standards of patient care within public hospitals, provision of

governance, oversight and control of the public health system and the statutory health

organisations within it, as well as in relation to other services provided by the public health

system, and to facilitate the efficient and economic operation of the public health system

(s.122).

The Act allows the Health Secretary to enter into performance agreements with Local Health

Districts in relation to the provision of health services and health support services (s.126). The

performance agreement may include provisions of a service agreement.

Under the Act the Minister may attach conditions to the payment of any subsidy (or part of any

subsidy) (s.127). As a condition of subsidy all funding provided for specific purposes must be

used for those purposes unless approved by the Health Secretary.

4.2 Variation of the Agreement

The Agreement may be amended at any time by agreement in writing between the

Organisation and the Ministry.

The Agreement may also be varied by the Secretary or the Minister in exercise of their general

powers under the Act, including determination of the role, functions and activities of Local

Health Districts (s. 32).

Any updates to finance or activity information further to the original contents of the Agreement

will be provided through separate documents that may be issued by the Ministry in the course

of the year.

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4.3 National Agreement - Hospital funding and health reform

The Council of Australian Governments (COAG) has reaffirmed that providing universal health

care for all Australians is a shared priority and agreed in a Heads of Agreement for public

hospitals funding from 1 July 2017 to 30 June 2020. That Agreement maintains activity based

funding and the national efficient price. There is a focus on improved patient safety, quality of

services and reduced unnecessary hospitalisations. The Commonwealth will continue its focus

on reforms in primary care that are designed to improve patient outcomes and reduce

avoidable hospital admissions. See http://www.coag.gov.au/agreements

4.4 Governance

The Organisation must ensure that all applicable duties, obligations and accountabilities are

understood and complied with, and that services are provided in a manner consistent with all

NSW Health policies, procedures, plans, circulars, inter-agency agreements, Ministerial

directives and other instruments and statutory obligations.

The Organisation is to ensure

Timely implementation of Coroner’s findings and recommendations, as well as

recommendations of Root Cause Analyses

Active participation in state-wide reviews

4.4.1 Clinical Governance

NSW public health services are accredited against the National Safety and Quality Health

Service Standards.

https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/nsqhs-

standards-second-edition/

The Australian Safety and Quality Framework for Health Care provides a set of guiding

principles that can assist Health Services with their clinical governance obligations.

https://www.safetyandquality.gov.au/national-priorities/australian-safety-and-quality-

framework-for-health-care/

The NSW Patient Safety and Clinical Quality Program provides an important framework for

improvements to clinical quality.

http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2005_608.pdf

4.4.2 Corporate Governance

The Organisation must ensure services are delivered in a manner consistent with the NSW

Health Corporate Governance and Accountability Compendium (the Compendium) seven

corporate governance standards. The Compendium is at:

http://www.health.nsw.gov.au/policies/manuals/pages/corporate-governance-

compendium.aspx

Where applicable, the Organisation is to:

Provide required reports in accordance with timeframes advised by the Ministry;

Review and update the Manual of Delegations (PD2012_059) to ensure currency;

Ensure recommendations of the NSW Auditor-General, the Public Accounts Committee

and the NSW Ombudsman, where accepted by NSW Health, are actioned in a timely and

effective manner, and that repeat audit issues are avoided.

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4.4.3 Procurement Governance

The Organisation must ensure procurement of goods and services complies with the NSW

Health Procurement Policy, the key policy governing procurement practices for all NSW

Health organisations. The NSW Health Procurement Policy is to be applied in conjunction with

procedures detailed in the NSW Health Goods and Services Procurement Policy Directive

(PD2018_030). These documents detail the requirements of all staff undertaking procurement

or disposal of goods and services on behalf of NSW Health.

https://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=PD2018_030

4.4.4 Safety and Quality Accounts

The Organisation will complete a Safety and Quality Account to document achievements, and

affirm an ongoing commitment to improving and integrating safety and quality into their

functions. The Account provides information about the safety and quality of care delivered by

the Organisation, including key state-wide mandatory measures, patient safety priorities,

service improvements, integration initiatives, and three additional locally selected high priority

measures. Locally selected high priority measures must demonstrate a holistic approach to

safety and quality, and at least one of these must focus on improving safety and quality for

Aboriginal patients.

The Account must also demonstrate how the Organisation meets Standard 1. Clinical

Governance, of the National Safety and Quality Health Service Standards, which describes

the clinical governance, and safety and quality systems that are required to maintain and

improve the reliability, safety and quality of health care, and improve health outcomes for

patients. Standard 1 ensures that frontline clinicians, managers and members of governing

bodies, such as boards, are accountable to patients and the community for assuring the

delivery of health services that are safe, effective, integrated, high quality and continuously

improving.

Consistent with the National Health Reform Agreement, The Organisation must continue to

focus on reducing the incidence of hospital acquired complications. Through the Purchasing

Framework, NSW Health has incentivised Districts and Networks to invest in quality

improvement initiatives that specifically target these complications. It is expected that the

Safety and Quality Account articulates these initiatives and provides details on approaches

and outcomes.

4.4.5 Performance Framework

Service Agreements are a central component of the NSW Health Performance Framework,

which documents how the Ministry monitors and assesses the performance of public sector

health services to achieve expected service levels, financial performance, governance and

other requirements.

The performance of a Health Service is assessed on whether the organisation is meeting the

strategic objectives for NSW Health and government, the Premier’s priorities and performance

against key performance indicators. The availability and implementation of governance

structures and processes, and whether there has been a significant critical incident or sentinel

event also influences the assessment.

The Framework sets out performance improvement approaches, responses to performance

concerns and management processes that support the achievement of outcomes in

accordance with NSW Health and government policies and priorities.

Performance concerns will be raised with the Organisation for focused discussion at

performance review meetings in line with the NSW Health Performance Framework available

at: http://www.health.nsw.gov.au/Performance/Pages/frameworks.aspx

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Schedule A: Strategies and Priorities

The delivery of NSW Health strategies and priorities is the responsibility of the Ministry, NSW

Health Services and Support Organisations. These are to be reflected in the strategic,

operational and business plans of these entities.

NSW Government Priorities

The NSW Government has outlined their priorities for their third term:

Building a strong economy

Providing high-quality education

Creating well connected communities

Providing world class customer service

Tackling longstanding social challenges

NSW Health will contribute to the NSW Government’s priorities in a number of ways:

Our focus and commitment to put the patient at the centre of all that we do will

continue and be expanded.

We will continue to deliver new and improved health infrastructure and digital

solutions that connect communities and improve quality of life for people in rural,

regional and metropolitan areas.

We will help develop solutions to tackle longstanding social challenges including

intergenerational disadvantage, suicide and indigenous disadvantage.

NSW Health staff will continue to work together to deliver a sustainable health system that

delivers outcomes that matter to patients and community, is personalised, invests in wellness

and is digitally enabled.

Election Commitments

NSW Health is responsible for the delivery of 50 election commitments over the period to

March 2023. The Ministry of Health will lead the delivery of these commitments with support

from Health Services and Support Organisations.

Minister’s Priority

NSW Health will strive for engagement, empathy and excellence to promote a positive and

compassionate culture that is shared by managers, front-line clinical and support staff alike.

This culture will ensure the delivery of safe, appropriate, high quality care for our patients and

communities. To do this, Health Services are to continue to effectively engage with the

community, and ensure that managers at all levels are visible and working collaboratively

with staff, patients and carers within their organisation, service or unit. These requirements

will form a critical element of the Safety and Quality Account.

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NSW State Health Plan: Towards 2021

The NSW State Health Plan: Towards 2021 provides a strategic framework which brings

together NSW Health’s existing plans, programs and policies and sets priorities across the

system for the delivery of the right care, in the right place, at the right time. See

http://www.health.nsw.gov.au/statehealthplan/Publications/NSW-state-health-plan-towards-

2021.pdf

NSW Health Strategic Priorities 2019-20

Value based healthcare

Value based healthcare (VBHC) is a framework for organising health systems around the

concept of value. In NSW value based healthcare means continually striving to deliver care

that improves:

The health outcomes that matter to patients

The experience of receiving care

The experience of providing care

The effectiveness and efficiency of care

VBHC builds on our long-held emphasis on safety and quality by increasing the focus on

delivering health outcomes and the experience of receiving care as defined from the patient

perspective; systematically measuring outcomes (rather than outputs) and using insights to

further inform resource allocation decisions; and a more integrated approach across the full

cycle of care.

Improving patient experience

Consistent with NSW Government priorities to improve customers experience for NSW

residents, NSW Health is committed to enhancing patients and their carer’s experience of

care. A structured approach to patient experience that supports a cohesive, strategic and

measurable approach is being progressed. An audit in 2018 of initiatives underway across

the NSW Health system identified 260 initiatives across districts, networks and pillar

organisations to enhance the patient experience.

In 2019-20, the Ministry of Health will work closely with Health Services and Support

Organisations to progress the strategic approach to improving patient experience across the

NSW public health system.

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Local Priorities

Under the Health Services Act 1997, Boards have the function of ensuring that Districts and

Networks develop strategic plans to guide the delivery of services, and for approving these

plans.

The Organisation is responsible for developing the following plans with Board oversight:

Strategic Plan

Clinical Services Plans

Safety and Quality Account and subsequent Safety and Quality Plan

Workforce Plan

Corporate Governance Plan

Asset Strategic Plan

It is recognised that the Organisation will implement local priorities to meet the needs of their

respective populations.

The Organisation’s local priorities for 2019/20 are as follows:

1. Investigate opportunities for using s19(2) Medicare exemption for increasing nurse

practitioner and GP telehealth services

2. Work with the Coomealla Health Aboriginal Corporation; the Western NSW Primary

Health Network; and the Rural Doctors Network on a GP model of care in the Wentworth

Shire region to coincide with the opening of the new HealthOne facility at Buronga

3. Work with Aboriginal people in the co-design of health services redevelopment in

particular: child and family health; mental health and drug & alcohol; and chronic disease

prevention and management

4. Develop the workforce to enhance their skills and knowledge through jobshare

opportunities with partner organisations

5. Implement the HealthOne projects in the Tibooburra community and the Southern Cluster

region to enhance models of care

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Schedule B: Services and Networks

Services

The Organisation is to maintain up to date information for the public on its website

regarding its facilities and services including population health, inpatient services,

community health, other non-inpatient services and multipurpose services (where

applicable), in accordance with approved role delineation levels.

The Organisation is also to maintain up to date details of:

Affiliated Health Organisations (AHOs) in receipt of Subsidies in respect of services

recognised under Schedule 3 of the Health Services Act 1997. Note that annual Service

Agreements are to be in place between the Organisation and AHOs.

Non-Government Organisations (NGOs) for which the Commissioning Agency is the

Organisation, noting that NGOs for which the Commissioning Agency is the NSW

Ministry of Health are included in NSW Health Annual Reports.

Primary Health Networks with which the Organisation has a relationship.

Networks and Services Provided to Other Organisations

Each NSW Health service is a part of integrated networks of clinical services that aim to

ensure timely access to appropriate care for all eligible patients. The Organisation must

ensure effective contribution, where applicable, to the operation of statewide and local

networks of retrieval, specialty service transfer and inter-district networked specialty

clinical services.

Key Clinical Services Provided to Other Health Services

The Organisation will ensure continued provision of access by other Districts and Health

Services, as set out in the table below. The respective responsibilities should be

incorporated in formal service agreements between the parties.

Service Recipient Health Service

NA

Note that New South Wales prisoners are entitled to free inpatient and non-inpatient services in NSW public hospitals (PD2016_024 – Health Services Act 1997 - Scale of Fees for Hospital and Other Services, or as updated).

Non-clinical Services and Other Functions Provided to Other Health Services

Where the Organisation has the lead or joint lead role, continued provision to other

Districts and Health Services is to be ensured as follows.

Service or function Recipient Health Service

Travel booking services Western NSWLHD

HealthShare

EHealth NSW

Agency for Clinical Innovation

Clinical Excellence Commission

Health Education and Training Institute

Bureau of Health Information

Murrumbidgee LHD (reconciliation services only)

Cancer Institute NSW

Clinical Waste Collection Justice Health and Forensic Mental Health Network

NSW Ambulance

Laundry NSW Health Pathology

NSW Ambulance

Oral Health Services Justice Health and Forensic Mental Health Network

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Cross District Referral Networks

Districts and Networks are part of a referral network with other relevant services, and must

ensure the continued effective operation of these networks, especially the following:

Critical Care Tertiary Referral Networks and Transfer of Care (Adults) - (PD2018_011)

Interfacility Transfer Process for Adult Patients Requiring Specialist Care - (PD2011_031)

Critical Care Tertiary Referral Networks (Paediatrics) - (PD2010_030)

Children and Adolescents - Inter-Facility Transfers –(PD2010_031)

Critical Care Tertiary Referral Networks (Perinatal) – (PD2010_069)

NSW State Spinal Cord Injury Referral Network - (PD2018_011)

NSW Major Trauma Referral Networks (Adults) - (PD2018_011)

Children and Adolescents with Mental Health Problems Requiring Inpatient Care -

(PD2011_016)

Roles and responsibilities for Mental Health Intensive Care Units (MHICU), including

standardisation of referral and clinical handover procedures and pathways, the role of the

primary referral centre in securing a MHICU bed, and the standardisation of escalation

processes will continue to be a focus for NSW Health in 2019/20.

Supra LHD Services

Supra LHD Services are provided across District, Network and Health Service boundaries

and are characterised by a combination of the following factors:

Services are provided on behalf of the State; that is, a significant proportion of service users

are from outside the host District’s/Network’s catchment

Services are provided from limited sites across NSW

Services are high cost with low-volume activity

Individual clinicians or teams in Supra LHD services have specialised skills

Provision of the service is dependent on highly specialised equipment and/or support services

Significant investment in infrastructure is required

Ensuring equitable access to Supra LHD Services will be a key focus.

The following information is included in all Service Agreements to provide an overview of

recognised Supra LHD Services and Nationally Funded Centres in NSW.

Supra LHD Service Measurement

Unit Locations Service Requirement

Adult Intensive Care Unit

Beds/NWAU Royal North Shore (38)

Westmead (49)

Nepean (21)

Liverpool (34+2/586 NWAU 2019/20)

Royal Prince Alfred (51)

Concord (16)

Prince of Wales (22)

John Hunter (24+2/586 NWAU 2019/20)

St Vincent’s (21)

St George (36)

Services to be provided in accordance with Critical Care Tertiary Referral Networks & Transfer of Care (Adults) PD2018_011.

Units with new beds in 2019/20 will need to demonstrate networked arrangements with identified partner Level 4 AICU services, in accordance with the recommended standards in the NSW Agency for Clinical Innovation’s Intensive Care Service Model: NSW Level 4 Adult Intensive Care Unit

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Supra LHD Service Measurement

Unit Locations Service Requirement

Mental Health Intensive Care

Access Concord - McKay East Ward

Hornsby - Mental Health Intensive Care Unit

Prince Of Wales - Mental Health Intensive Care Unit

Cumberland – Yaralla Ward

Orange Health Service - Orange Lachlan ICU

Mater, Hunter New England – Psychiatric Intensive Care Unit

Provision of equitable access.

Adult Liver Transplant Access Royal Prince Alfred Dependent on the availability of matched organs, in accordance with The Transplantation Society of Australia and New Zealand, Clinical Guidelines for Organ Transplantation from Deceased Donors, Version 1.0— April 2016

State Spinal Cord Injury Service (adult and paediatric)

Access Prince of Wales Royal North Shore

Royal Rehabilitation Centre, Sydney

SCHN – Westmead and Randwick

Services to be provided in accordance with Critical Care Tertiary Referral Networks & Transfer of Care (Adults) PD2018_011 and Critical Care Tertiary Referral Networks (Paediatrics) PD2010_030

Blood and Marrow Transplantation – Allogeneic

Number St Vincent's (38) Westmead (71) Royal Prince Alfred (26) Liverpool (18) Royal North Shore (26) SCHN Randwick (26)

SCHN Westmead (26)

Provision of equitable access

Blood and Marrow Transplant Laboratory

Access St Vincent's - to Gosford Westmead – to Nepean, Wollongong, SCHN at Westmead

Provision of equitable access

Complex Epilepsy Access Westmead Royal Prince Alfred Prince of Wales SCHN

Provision of equitable access.

Extracorporeal Membrane Oxygenation Retrieval

Access Royal Prince Alfred St Vincent's

Services to be provided in accordance with Critical Care Tertiary Referral Networks & Transfer of Care (Adults) PD2018_011.

Heart, Lung and Heart Lung Transplantation

Number of Transplants

St Vincent's (96+10/420 NWAU 2019/20)

To provide Heart, Lung and Heart Lung transplantation services at a level where all available donor organs with matched recipients are transplanted. These services will be available equitably to all referrals.

Dependent on the availability of matched organs in accordance with The Transplantation Society of Australia and New Zealand, Clinical Guidelines for Organ Transplantation from Deceased Donors, Version 1.1— May 2017.

High Risk Maternity Access Royal Prince Alfred Royal North Shore

Royal Hospital for Women Liverpool John Hunter Nepean Westmead

Access for all women with high risk pregnancies, in accordance with NSW Critical Care Networks (Perinatal) PD2010_069.

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Supra LHD Service Measurement

Unit Locations Service Requirement

Neonatal Intensive Care Service

Beds/NWAU SCHN Randwick (4)

SCHN Westmead (23)

Royal Prince Alfred (22)

Royal North Shore (16)

Royal Hospital for Women (16)

Liverpool (13+1/330 NWAU 2019/20)

John Hunter (19)

Nepean (12)

Westmead (24)

Services to be provided in accordance with NSW Critical Care Networks (Perinatal) PD2010_069

Peritonectomy NWAU St George (116)

Royal Prince Alfred (60)

Provision of equitable access for referrals as per agreed protocols

Paediatric Intensive Care

NWAU SCHN Randwick (13)

SCHN Westmead (22)

John Hunter (up to 4)

Services to be provided in accordance with NSW Critical Care Networks (Paediatrics) PD2010_030

Severe Burn Service Access Concord

Royal North Shore

SCHN Westmead

Services to be provided in accordance with Critical Care Tertiary Referral Networks & Transfer of Care (Adults) PD2018_011 and NSW Burn Transfer Guidelines (ACI 2014) and Critical Care Tertiary Referral Networks (Paediatrics) PD2010_030

Sydney Dialysis Centre

Access Royal North Shore In accordance with 2013 Sydney Dialysis Centre funding agreement with Northern Sydney Local Health District

Hyperbaric Medicine Access Prince of Wales Provision of equitable access to hyperbaric services.

Haematopoietic Stem Cell Transplantation for Severe Scleroderma

Number of Transplants

St Vincent's (10) Provision of equitable access for all referrals as per NSW Referral and Protocol for Haematopoietic Stem Cell Transplantation for Systemic Sclerosis, BMT Network, Agency for Clinical Innovation, 2016.

Neurointervention Services endovascular clot retrieval for Acute Ischaemic Stroke

Access Royal Prince Alfred

Prince of Wales

Liverpool

John Hunter

SCHN

As per the NSW Health strategic report - Planning for NSW NI Services to 2031

Organ Retrieval Services

Access St Vincent’s

Royal Prince Alfred

Westmead

Services are to be provided in line with the clinical service plan for organ retrieval. Services should focus on a model which is safe, sustainable and meets donor family needs, clinical needs and reflects best practice.

Norwood Procedure for Hypoplastic Left Heart Syndrome (HLHS)

Access SCHN (Westmead) Provision of equitable access for all referrals

Nationally Funded Centres

Service Name Locations Service Requirement

Pancreas Transplantation – Nationally Funded Centre

Westmead

As per Nationally Funded Centre Agreement - Access for all patients across Australia accepted onto Nationally Funded Centre program

Paediatric Liver Transplantation – Nationally Funded Centre

SCHN Westmead

Islet Cell Transplantation – Nationally Funded Centre

Westmead

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Schedule C: Budget

Part 1

A B C D E F G H I

FWTarget Volume

(NWAU19)

Volume

(Admissions &

Attendances)

Indicative only

State Price

per NWAU19

LHD/SHN

Projected

Average Cost

per NWAU19

Initial Budget

2019/20 ($ '000)

2018/19

Annualised

Budget

($ '000)

Variance Initial

and Annualised

($ '000)

Variance

(%)

Volume

Forecast

2018/19

(NWAU19)

Acute Admitted 5,452 7,688 $26,714 $25,900 $814 5,329

Emergency Department 2,028 23,983 $9,966 $9,709 $257 2,008

Non Admitted Patients (Including Dental) 2,460 49,465 $12,049 $11,551 $498 2,400

A Total 9,941 81,137 $48,729 $47,160 $1,569 3.3% 9,737

Sub-Acute Services - Admitted 398 149 $1,941 $1,839 $102 382

Sub-Acute Services - Non Admitted 87 $426 $417 $10 87

B Total 484 149 $2,368 $2,256 $112 5.0% 469

Mental Health - Admitted (Acute and Sub-Acute) 948 258 $4,667 $4,551 $117 945

Mental Health - Non Admitted 657 11,363 $7,864 $7,679 $185 655

C Total 1,606 11,621 $12,532 $12,229 $302 2.5% 1,601

Block Funding Allocation

Block Funded Hospitals (Small Hospitals) $19,746 $19,301 $445

Block Funded Services In-Scope

- Teaching, Training and Research $2,298 $2,246 $52

D Total $22,044 $21,547 $497 2.3%

E State Only Block Funded Services Total $16,011 $15,650 $361 2.3%

Transition Grant $1,559

Recognised Operational Cost (ROC) $8,108

Transition Grant (excluding Mental Health) and ROCᵝ $9,667 $9,449 $218 2.3%

G Gross-Up (Private Patient Service Adjustments) $1,824 $1,783 $41 2.3%

Provision for Specific Initiatives & TMF Adjustments (not included above)

Data Improvement Project $500

Integrated Care $360

Leading Better Value Care Program $300

Other Block Growth and Purchasing Adjustors $640

Psychologists for drought affected areas $125

2015 Election Commitment - Additional Nursing, Midwifery and Support positions $48

Procurement Savings -$46

Efficiency dividends 2019-20 -$717

H Total $1,210 $1,210

I Restricted Financial Asset Expenses

J Depreciation (General Funds only) $6,844 $6,844

K Total Expenses (K=A+B+C+D+E+F+G+H+I+J) $121,228 $116,918 $4,310 3.7%

L Other - Gain/Loss on disposal of assets etc

M LHD Revenue -$116,426 -$109,969 -$6,457

N Net Result (N=K+L+M) $4,802 $6,950 -$2,148

General Note: ABF growth is funded at 77% of the State Price

ᵝ Part of the Acute, ED and Subacute Admitted transition grant has been used to fund growth (see Schedule C glossary)

$5,819

F

Sc

he

du

le C

Pa

rt 1

Far West LHD - Budget 2019/20

2019/20 BUDGET Comparative Data

$4,925 $5,819

$4,925 $5,819

$4,925

16

Part 2

2019/20

$ (000's)

Government Grants

A Subsidy* -$57,239

B In-Scope Services - Block Funded -$25,004

C Out of Scope Services - Block Funded -$13,385

D Capital Subsidy -$2,147

E Crown Acceptance (Super, LSL) -$1,554

F -$99,329

Own Source revenue

G GF Revenue -$17,059

H Restricted Financial Asset Revenue -$38

I -$17,097

J -$116,426

K Total Expense Budget - General Funds $121,228

L Restricted Financial Asset Expense Budget

M Other Expense Budget

N $121,228

O $4,802

Net Result Represented by:

P Asset Movements -$4,660

Q Liability Movements -$142

R Entity Transfers

S -$4,802

Note:

The minimum weekly cash reserve buffer for unrestricted cash at bank has been updated for FY

2019/20 to $0.1m and has been reduced by approximately 75% of the FY 2018/19 buffer as a result of

the transition of creditor payments and PAYG remittance to HealthShare and HealthShare managed

bank accounts from the 1st July 2019. Based on final June 2019 cash balances, adjustments will be

made in July 2019 to ensure alignment with the cash buffer requirements of NSW Treasury Circular

TC15_01 Cash Management – Expanding the Scope of the Treasury Banking System.

The Ministry will closely monitor cash at bank balances during the year to ensure compliance with this

NSW Treasury policy.

* The subsidy amount does not include items E and G, which are revenue receipts retained by the

LHDs/SHNs and sit outside the National Pool.

Sc

he

du

le C

Pa

rt 2

Far West LHD

Total Government Contribution (F=A+B+C+D+E)

Total Own Source Revenue (I=G+H)

Total Revenue (J=F+I)

Total Expense Budget as per Attachment C Part 1 (N=K+L+M)

Net Result (O=J+N)

Total (S=P+Q+R)

17

Part 3

$ (000's)

HS Service Centres $450

HS Ambulance Make Ready

HS Service Centres Warehousing

HS Enable NSW $243

HS Food Services

HS Soft Service Charges

HS Linen Services

HS IPTAAS $2,426

HS Fleet Services $873

HS Patient Transport Services

HS MEAPP (quarterly)

$3,991

EH Corporate IT & SPA $2,280

EH Recoups $630

$2,910

Interhospital Ambulance Transports $1,363

Interhospital Ambulance NETS $32

$1,396

$7

Pa

yro

ll

$72,750

MoH Loan Repayments

Treasury Loan (SEDA)

Blood and Blood Products $172

NSW Pathology $1,357

Compacks (HSSG) $277

TMF Insurances (WC, MV & Property) $1,242

Creditor Payments $37,836

Energy Australia $1,146

$123,084

Note:

Total eHealth Charges

IH T

ran

sp

ort

s

Total Interhospital Ambulance Charges

Interhospital NETS Charges - SCHN

2019/20Shared Services & Consolidated Statewide Payment Schedule

Far West LHD

HS

Ch

arg

es

Total HSS Charges

eH

ea

lth

Total Payroll

Lo

an

s

Total Loans

Total

This schedule represents initial estimates of Statewide recoveries processed by the Ministry on behalf

of Service Providers. LHD's/Health Entities are responsible for regularly reviewing these estimates

and liaising with the Ministry where there are discrepancies. The Ministry will work with LHD's/Health

Entities and Service Providers throughout the year to ensure cash held back for these payments

reflects actual trends. Consistent with prior years procedures, a mid year review will occur in January

with further adjustments made if required.

Commencing 2019/20 two additional holdbacks have been included to reflect new statewide payment

and recovery processes for Creditors and PAYG. Amendments will also be made to the subsidy

sheets in 2019/20 to incorporate contributions from other sources to cover subsidy shortfalls as a

result of the additional holdbacks.

Sc

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Pa

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18

Part 4

2019/20 National Health Funding Body Service Agreement - Far West LHD

Acute

ED

Mental Health

Sub Acute

Non Admitted

Total 10,812 $9,180,332

Period: 1 July 2019 - 30 June 2020

Sc

he

du

le C

Pa

rt 4

National Reform Agreement In-

Scope Estimated National

Weighted Activity Units

Commonwealth

Funding

Contribution

5,379

1,988

Activity Based Funding Total 10,812

Block Funding Total $9,180,332

1,037

446

1,963

19

Capital Program

FAR WEST LHD

Local Funds

2019/20

$ $ $ $ $ $ $ $

WORKS IN PROGRESS

Minor Works & Equipment >$10,000 Program P51069 n.a - - 1,499,000 1,329,300 169,700 - -

Remote Staff Accommodation at Ivanhoe and Wilcannia P56419 493,000 273,000 220,000 220,000 220,000 - - -

Broken Hill Health Service (BHHS) Medical Imaging Breast Screen Refurbishment P56422 494,000 33,000 461,000 461,000 461,000 - - -

Wilcannia Aged Care Outdoor Space P56424 82,000 - 82,000 82,000 82,000 - - -

Broken Hill Health Service (BHHS) Renovation of Mental Health Inpatients Unit (MHIPU) P56418 84,000 29,365 54,635 54,635 54,635 - - -

TOTAL WORKS IN PROGRESS 1,153,000 335,365 817,635 2,316,635 2,146,935 169,700 - -

1,153,000 335,365 817,635 2,316,635 2,146,935 169,700 - -

Notes:

Expenditure needs to remain within the Capital Expenditure Authorisation Limits (CEAL) indicated above

The above budgets do not include allocations for new FY20 Locally Funded Initiative (LFI) Projects or Right of Use Assets (Leases) Projects. These budgets will be issued through a separate process.

Minor Works & Equipment >$10,000 Program is an annual allocation with no Total Estimated Cost

Cost to Complete

at

30 June 2019

Capital Budget

Allocation

2019/20

2019/20 Capital Budget Allocation by Source of Funds

Confund

2019/20

Revenue

2019/20

Lease Liabilities

2019/20

TOTAL CAPITAL EXPENDITURE AUTHORISATION LIMIT MANAGED BY FAR WEST LHD

PROJECTS MANAGED BY HEALTH SERVICE

2019/20 Capital Projects Proj

ect

Code Estimated Total

Cost

2019/20

Estimated

Expenditure to 30

June 2019

20

Schedule D: Purchased Volumes

Growth Investment Strategic Priority

$’000 NWAU19 Performance

Metric

Activity Growth inclusive of Local Priority Issues

Acute 2 - 5,452 See Schedule E

Emergency Department 2.4 - 2,028 See Schedule E

Sub-Acute Admitted 2 - 398 See Schedule E

Sub and Non Acute Inpatient Services – Palliative Care Component

3.3 - 129 See Schedule E

Non-Admitted 2 / 3 - 1,914 See Schedule E

Public Dental Clinical Service – Total Dental Activity (DWAU)

1 - 2,159 See Schedule E

Mental Health Admitted 3.2 - 948 See Schedule E

Mental Health Non-Admitted 3.2 - 657 See Schedule E

Alcohol and other drug related Admitted 1.3 - 39 See Schedule E

Alcohol and other drug related Non Admitted 1.3 - 322 See Schedule E

Service Investment

Service Enhancement Inclusive of Broken Hill Paediatric Oncology Unit workforce, Medical Oncology and Medical Day Only Unit, and Aboriginal Health Workers for ED and wards.

2 789 - Activity of service

enhancement identified

Strategic Priority Target Performance

Metric

STATE PRIORITY

Elective Surgery Volumes

Number of Admissions from Surgical Waiting List - Children <16 Years Old

2.4 41 Number

Number of Admissions from Surgical Waiting List – Cataract extraction

2.4 190 Number

21

Growth Investment Strategic Priority

$ ‘000 NWAU19 Performance Metric

NSW HEALTH STRATEGIC PRIORITIES

Providing World Class Clinical Care Where Patient Safety is First

Leading Better Value Care Program – Implementation Support Funding

2.2 300 - Performance against LBVC Deliverables

Enable eHealth, Health Information and Data Analytics

Data Improvement Project

Data improvement project includes $200,000 EBI program, $100,000 Data Quality, and $200,000 Intra-health Transfer to EBI central program.

6.4 500 -

Established Local Governance for Edward Transition, Completion of Impact Assessment, Participation in extract test work package.

Integrate Systems to Deliver Truly Connected Care

Integrated Care (IC) Strategy

New allocation for 2019/20 3.1 360 -

Adoption and implementation in 2019-20 of one scaled IC initiative (as per Ministry of Health shortlist). All patients enrolled in the Patient Flow Portal (PFP) for ongoing monitoring; PFP data will inform regular evaluation.

Special Considerations in Baseline Investment

Strategic Priority

$ ‘000 NWAU19 Performance Metric

Integrate Systems to Deliver Truly Connected Care

Integrated Care (IC) Strategy Weight adjusted Block funding

3.1 211 -

Adoption and implementation in 2019-20 of one scaled IC initiative (as per Ministry of Health shortlist). All patients enrolled in the Patient Flow Portal (PFP) for ongoing monitoring; PFP data will inform regular evaluation.

Integrated Care for People with Chronic Conditions (ICPCC) The ICPCC purchasing model for 2019/20 converts 50% of the existing recurrent funding for ICPCC into purchased activity for each District/Network. This is shown as NWAU for each District/Network.

3.1 69 14

Identify patients using Risk Stratification in Patient Flow Portal (PFP), and use PFP for ongoing monitoring of patients within ICPCC. PFP data will inform evaluation.

Clinical Redesign of NSW Health Responses to Violence, Abuse and Neglect (VAN)

3.5 250 -

Participate in monitoring and evaluation activities as described in the funding agreement Provide integrated 24/7 psychosocial and Medical Forensic responses for victims of Domestic and Family Violence, Child Physical Abuse and Neglect, and Sexual Assault. Provide community development and outreach services for sexual assault.

22

Schedule E: Performance against Strategies and Objectives

Key Performance Indicators

The performance of the Organisation is assessed in terms of whether it is meeting key

performance indicator targets for NSW Health Strategic Priorities.

Performing Performance at, or better than, target

Underperforming Performance within a tolerance range

X Not performing Performance outside the tolerance threshold

Detailed specifications for the key performance indicators are provided in the Service Agreement

Data Supplement along with the list of improvement measures that will be tracked by business

owners within the Ministry. See:

http://internal4.health.nsw.gov.au/hird/browse_data_resources.cfm?selinit=K

The Data Supplement maps indicators and measures to key strategic programs including:

Premier’s and State Priorities

Election Commitments

Better Value Care

Patient Safety First

Mental Health Reform

Outcome Budgeting

Strategic Deliverables

Key deliverables under the NSW Health Strategic Priorities 2019-20 will also be monitored, noting

that process key performance indicators and milestones are held in the detailed Operational

Plans developed by the Organisation.

23

A. Key Performance Indicators

Strategic Priority

Safety & Quality

Framework

Domain

Measure Target Not Performing

X

Under Performing

Performing

Strategy 1: Keep People Healthy

1.1 Effectiveness Childhood Obesity –Children with height and weight recorded (%)

≥70 <65 ≥ 65 and <70 ≥70

Equity

Smoking During Pregnancy - At any time (%):

1.2/1.6

Aboriginal women >2% decrease

on previous year

Increase on previous year

0 to <2% decrease on previous year

>2% decrease on previous

year

Non-aboriginal women >0.5%

decrease on previous year

Increase on previous year

0 to <0.5% decrease on previous year

>0.5% decrease on previous year

Effectiveness Pregnant Women Quitting Smoking - By second half of pregnancy (%)

≥4% increase on previous

year

<1% increase on previous

year

≥ 1 and < 4% increase on

previous year

≥4% increase on previous

year

1.3 Timeliness & Accessibility

Hospital Drug and Alcohol Consultation Liaison - number of consultations (% increase)

No change or increase from previous year

≥10% decrease on previous year

<10% decrease on previous year

No change or increase from previous year

1.4 Effectiveness

Hepatitis C Antiviral Treatment Initiation –

Direct acting by District residents: Variance

(%)

Individual -

See Data Supplement

<98% of target

≥98% and <100% of

target

≥100% of target

1.6 Effectiveness Get Healthy Information and Coaching Service - Get Healthy In Pregnancy Referrals (% increase)

Individual - See Data

Supplement <90 ≥90 and <100 ≥100

Strategy 2: Provide World-Class Clinical Care Where Patient Safety is First

2.1 Safety

Fall-related injuries in hospital – Resulting

in fracture or intracranial injury

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

3rd or 4th degree perineal lacerations during delivery

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Hospital acquired venous thromboembolism

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Hospital acquired pressure injuries

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement -

Healthcare associated infections

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Surgical complications requiring unplanned return to theatre\

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement -

Hospital acquired medication complications

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Hospital acquired neonatal birth trauma (Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Hospital acquired respiratory complications

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Hospital acquired renal failure

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Hospital acquired gastrointestinal bleeding

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Hospital acquired cardiac complications

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

24

Strategic Priority

Safety & Quality

Framework

Domain

Measure Target Not Performing

X

Under Performing

Performing

2.1 Safety

Hospital acquired delirium

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Hospital acquired malnutrition

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Hospital acquired persistent incontinence

(Rate per 10,000 episodes of care)

Individual -

See Data Supplement

Discharge against medical advice for Aboriginal in-patients (%)

Individual – See Data

Supplement

Increase on

previous year

0 and <1

decrease on

previous year

≥1

decrease on

previous year

2.1 Effectiveness

Unplanned Hospital Readmissions – All admissions within 28 days of separation (%):

All persons Decrease

from previous Year

Increase on previous year

No change Decrease

from previous Year

Aboriginal persons Decrease

from previous Year

Increase on previous year

No change Decrease

from previous Year

2.3 Patient Centred Culture

Overall Patient Experience Index (Number)

Adult admitted patients ≥8.5 <8.2 ≥8.2 and <8.5 ≥8.5

Emergency department ≥8.5 <8.2 ≥8.2 and <8.5 ≥8.5

Patient Engagement Index (Number)

Adult admitted patients ≥8.5 <8.2 ≥8.2 and <8.5 ≥8.5

Emergency department ≥8.5 <8.2 ≥8.2 and <8.5 ≥8.5

2.4 Timeliness & Accessibility

Elective Surgery:

Access Performance - Patients treated on time (%):

Category 1 100 <100 N/A 100

Category 2 ≥97 <93 ≥93

and <97 ≥97

Category 3 ≥97 <95 ≥95

and <97 ≥97

Overdue - Patients (Number):

Category 1 0 ≥1 N/A 0

Category 2 0 ≥1 N/A 0

Category 3 0 ≥1 N/A 0

Emergency Department:

Emergency treatment performance - Patients with total time in ED <= 4 hrs (%)

≥81 <71 ≥71

and <81 ≥81

Transfer of care – Patients transferred from ambulance to ED <= 30 minutes (%)

≥90 <80 ≥80

and <90 ≥90

Strategy 3: Integrate Systems to Deliver Truly Connected Care

3.1 Timeliness & Accessibility

Aged Care Assessment Timeliness - Average time from ACAT referral to delegation - Admitted patients (Days).

≤5 >6 >5 and

≤6 ≤5

3.2 Effectiveness

Mental Health:

Acute Post-Discharge Community Care - Follow up within seven days (%)

≥70 <50 ≥50 and

<70 ≥70

Acute readmission - Within 28 days (%) ≤13 >20 >13 and

≤20 ≤13

3.2 Appropriate-ness

Acute Seclusion Occurrence – (Episodes per 1,000 bed days)

<5.1 ≥5.1 N/A <5.1

25

Strategic Priority

Safety & Quality

Framework

Domain

Measure Target Not Performing

X

Under Performing

Performing

Acute Seclusion Duration – (Average Hours)

<4 >5.5 ≥4

and ≤5.5 <4

Safety Involuntary Patients Absconded – From

an inpatient mental health unit –Incident Types 1 and 2 (Number)

0 >0 N/A 0

Patient Centred Culture

Mental Health Consumer Experience: Mental Health consumers with a score of Very Good or Excellent (%)

≥80 <70 ≥70 and <80 ≥80

Timeliness & Accessibility

Emergency department extended stays: Mental Health presentations staying in ED > 24 hours (Number)

0 >5 >1 and <5 0

Patient Centred Culture

Mental Health Reform:

Pathways to Community Living - People transitioned to the community – (Number) (Applicable some LHDs only - see Data Supplement)

Increase on previous quarter

Decrease from previous

quarter No change

Increase on previous quarter

Peer Workforce Employment – Full time equivalents (FTEs) (Number)

Increase on previous quarter

Decrease from previous

quarter No change

Increase on previous quarter

3.5

Effectiveness

Domestic Violence Routine Screening – Routine Screens conducted (%)

≥70 <60 ≥60 and

<70 ≥70

Out of Home Care Health Pathway Program - Children and young people completing a primary health assessment (%)

100 <90 ≥90 and <100 100

Sexual Assault Services Initial Assessments – Referrals for victims of sexual assault receiving an initial psychosocial assessment (%)

≥80 <70 ≥70 and

<80 ≥80

Sustaining NSW Families Programs - Applicable LHDs only - see Data Supplement:

Families completing the program when child reached 2 years of age (%)

≥50 <45 ≥45 and <50 ≥50

Families enrolled and continuing in the

program (%) ≥65 <55 ≥55 and <65 ≥65

3.6 Patient Centred Culture

Electronic Discharge Summaries Completed - Sent electronically to State Clinical Repository (%)

Increase in YTD

percentage

Decrease in YTD

percentage

No change in YTD

percentage

Increase in YTD

percentage

Strategy 4: Develop and Support Our People and Culture

4.1

Patient Centred Culture

Staff Engagement - People Matter Survey Engagement Index - Variation from previous year (%)

≥ -1 ≤ -5 >-5 and < -1 ≥ -1

Workplace Culture - People Matter Survey Culture Index- Variation from previous year (%)

≥ -1 ≤ -5 >-5 and < -1 ≥ -1

Take action-People Matter Survey take action as a result of the survey- Variation from previous year (%)

≥ -1 ≤ -5 >-5 and < -1 ≥ -1

Efficiency Staff Performance Reviews - Within the last 12 months (%)

100 <85 >85 and <90 >90

4.4 Equity

Aboriginal Workforce Participation - Aboriginal Workforce as a proportion of total workforce at all salary levels (bands) and occupations (%)

1.8 Decrease

from previous Year

No change Increase on

previous Year

4.6 Safety Compensable Workplace Injury - Claims (% change)

≥10%

Decrease Increase

≥0

and <10% Decrease

≥10% Decrease

26

Strategic Priority

Safety & Quality

Framework

Domain

Measure Target Not Performing

X

Under Performing

Performing

Strategy 5: Support and Harness Health and Medical Research and Innovation

5.4 Research

Ethics Application Approvals - By the Human Research Ethics Committee within 45 calendar days - Involving more than low risk to participants (%).

≥95 <75 ≥75

and <95 ≥95

Research Governance Application Authorisations – Site specific within 15 calendar days - Involving more than low risk to participants - (%)

≥95 <75 ≥75

and <95 ≥95

Strategy 6: Enable eHealth, Health Information and Data Analytics

6.2 Efficiency See under 3.6 - Electronic Discharge Summaries

Strategy 7: Deliver Infrastructure for Impact and Transformation

7.2 Finance Capital Variation - Against Approved Budget (%)

On budget > +/- 10

of budget NA

< +/- 10

of budget

Strategy 8: Build Financial Sustainability and Robust Governance

8.1

Finance

Purchased Activity Volumes - Variance (%):

Acute admitted– NWAU

Individual - See Budget

> +/-2.0 > +/-1.0 and

≤ +/-2.0 ≤ +/-1.0

Emergency department – NWAU

Non-admitted patients – NWAU

Sub-acute services - Admitted – NWAU

Mental health – Admitted – NWAU

Mental health - Non admitted – NWAU

Alcohol and other drug related Admitted (NWAU)

See Purchased Volumes

> +/-2.0 > +/-1.0 and

≤ +/-2.0 ≤ +/-1.0

Alcohol and other drug related Non Admitted (NWAU)

Public dental clinical service - DWAU See

Purchased Volumes

> 2.0 > 1.0 and

≤ 2.0 ≤ 1.0

Expenditure Matched to Budget - General Fund -Variance (%)

On budget or Favourable

>0.5

Unfavourable

>0 and ≤ 0.5 Unfavourable

On budget or Favourable

Own Sourced Revenue Matched to Budget - General Fund - Variance (%)

On budget or Favourable

>0.5

Unfavourable

>0 and ≤ 0.5 Unfavourable

On budget or Favourable

Expenditure Projection- Projected General Fund – Actual %

Favourable or Equal to

March Forecast

Variation >2.0 of March Forecast

Variation >1.5 and

≤2.0

Variation <1.5 of March

Forecast

Revenue Projection - Projected General Fund – Actual %

Favourable or Equal to

March Forecast

Variation >2.0 of March Forecast

Variation >1.5 and

≤2.0

Variation <1.5 of March

Forecast

Efficiency Cost Ratio Performance - Cost per NWAU compared to state average - (%)

Decrease from

previous year

Average District Cost

greater than or equal to 1% of the State Price

Average District Cost greater than

but within 1% of the State

Price

Average District Cost less than the State Price

27

B. Strategic Deliverables

Value based healthcare

Value based healthcare (VBHC) is a framework for organising health systems around the concept

of value. In NSW value based healthcare means continually striving to deliver care that improves:

The health outcomes that matter to patients

The experience of receiving care

The experience of providing care

The effectiveness and efficiency of care

VBHC builds on our long-held emphasis on safety and quality by increasing the focus on delivering

health outcomes and the experience of receiving care as defined from the patient perspective;

systematically measuring outcomes (rather than outputs) and using insights to further inform

resource allocation decisions; and a more integrated approach across the full cycle of care.

Leading Better Value Care, Commissioning for Better Value and Integrating Care are three

programs helping to accelerate NSW Health’s move to value based healthcare.

Integrating Care

In 2019-20 the Ministry of Health has reinvigorated Integrating Care (IC) with a focus on scaling five

locally developed initiatives which will benefit patients and the system across NSW. The five scaled

initiatives are evidence-based and show benefits in line with the Quadruple Aim. They have been

selected because they demonstrate integration throughout the NSW Health system, and with

Primary Health Networks and other clusters.

The main roles and responsibilities in the IC Program are:

The Ministry of Health will continue as system manager and will articulate the priorities for

NSW Health. Performance against delivery of the priorities will be monitored in line with the

NSW Health Performance Framework.

Districts and Networks will determine local approaches to implement and deliver at least one of

the five Ministry selected IC initiatives in 2019-20. Districts and Networks may also continue to

provide services established through IC in 2017-18 and 2018-19 if deemed viable and locally

appropriate to do so.

The Pillars, in discussion with the Ministry, may support Districts and Networks in a flexible

manner that can be customised to meet state-wide and local needs, primarily to support

implementation and clinical redesign for the IC initiatives.

Districts and Networks will provide patient-level data to the Ministry of Health to assist

evaluation, monitoring and regular reporting of the IC initiatives at a local and state-wide level.

The Ministry will hold patient-level IC data and use existing linkage and de-identification

processes to support comprehensive measurement of the initiatives as required.

In 2019-20, Districts and Networks will:

Work with the Ministry of Health to implement at least one of the 2019-20 IC initiatives:

o ED to Community (EDC)

- IC EDC is an intensive case management approach for people who present to a hospital’s

Emergency Department ten times or more in a twelve month period.

- These people are likely to have multiple complex and chronic care needs.

o Paediatrics Network (PN)

- IC PN is a care approach that enables children with complex needs to receive care closer

to home where possible and appropriate, while also receiving specialist care where

required.

- Through upskilling local services, and enablers such as telehealth, children and families

can reduce travel time and receive coordinated care.

28

o Residential Aged Care (RAC)

- IC RAC recognises that outcomes for people living in Residential Aged Care Facilities

(RACF) could be improved during periods of illness.

- Through enabling people to be cared for at their place of residence, where appropriate,

rather than unnecessary transfer to hospital, patient experience and outcomes can be

enhanced.

o Specialist Outreach to Primary Care (SPC)

- IC SPC initiative aims to optimise patient care in the community through collaboration

between primary care and secondary care clinicians.

- Identified patients are included in a structured care coordination program to enable

appropriate care if they attend hospital, and while in the community.

o Vulnerable Families (VF)

- IC VF is an intensive care coordination intervention for families where the parents or

carers have complex health and social needs, and who have at least one child unborn to

17 years of age.

- The cohort are likely to experience barriers to engagement with the health system and

other social services including Education and Family and Community Services, and often

have multiple complex conditions.

Continue to implement, expand and embed implementation of the Integrated Care for People

with Chronic Conditions (ICPCC) initiative to support people who are identified as being at risk

of a future hospital admission.

Continue to provide and expand the reach of clinical services in the most appropriate care

setting for existing IC patients.

Participate in and provide data to inform monitoring, evaluation and other studies of IC

initiatives.

Utilise their IC teams to support the implementation, collection and use of identified Patient

Reported Measures and work with other district resources to support the broader work program

to embed IC approaches in the district.

Be expected to demonstrate improved health outcomes (clinical and patient reported),

experiences and possible activity benefits from implemented IC initiatives in their district.

Data for all Integrated Care patients should be captured in the Patient Flow Portal (PFP). This

tool is already available for Integrated Care for People with Chronic Conditions, and additional

modules will become available for all other Integrated Care initiatives. This will improve data

capture, and minimise the reporting burden for each LHD and SHN.

Leading Better Value Care

The Leading Better Value Care (LBVC) Program identifies and scales evidence-based initiatives

for specific diseases or conditions and supports their implementation in all local health districts

across the state. The LBVC Program has a strong focus on measurement and evaluation to show

the impact of care across the four domains of value.

The main roles and responsibilities in the LBVC Program are:

The Ministry of Health will continue as system manager and will articulate the priorities for

NSW Health. Performance against delivery of the priorities will be monitored in line with the

NSW Health Performance Framework.

Districts and Networks will continue to provide services established through LBVC in 2017-18

and 2018-19 and determine local approaches to deliver new LBVC initiatives in 2019-20.

The Pillars will continue to support Districts and Networks in a flexible manner that can be

customised to meet statewide and local needs and will support measurement activities as

required.

29

Districts and Networks will participate with Ministry of Health and Pillars in evaluation,

monitoring and regular reporting on the progress of the LBVC initiatives as specified in the

Monitoring and Evaluation Plans.

In 2019-20, districts and networks will:

Continue to provide and expand the reach of clinical services in the most appropriate care

setting for patients in LBVC Tranche 1 initiatives of Osteoporotic Refracture Prevention (ORP),

Osteoarthritis Chronic Care Program (OACCP), Renal Supportive Care (RSC) and High Risk

Foot Services (HRFS) through non-admitted services, including designated HERO clinics.

Continue to implement, expand and embed LBVC approaches, including but not limited to a

focus on activities outlined in Clinical Improvement Activity Briefs for Chronic Heart Failure

(CHF), Chronic Obstructive Pulmonary Disease (COPD) and Inpatient Management of

Diabetes.

Continue to sustain improvement work and spread when interventions are reliably practiced to

reduce falls and harm from falls in hospital. Districts should have a Sustainability Action Plan

(including actions on how to progress implementation endorsed by the district Executive) to

identify opportunities and risks to sustaining and spreading the Falls in Hospital Collaborative

improvements.

Participate in and provide data to inform monitoring, evaluation and other studies of LBVC

initiatives.

Utilise their PRMs Project Officer to support the implementation, collection and use of identified

Patient Reported Measures and work with other district resources to support the broader work

program to embed value-based healthcare approaches in the district.

Be expected to demonstrate improved health outcomes (clinical and patient reported),

experiences and activity benefits from all Tranche 1 initiatives as outlined in the monitoring and

evaluation plans.

Work with the Ministry of Health and Pillar agencies to implement LBVC Tranche 2 initiatives

for:

o Bronchiolitis: Implement and embed LBVC approaches as outlined in the Clinical

Improvement Activity Brief for the Bronchiolitis initiative including:

- Appropriate investigations for Bronchiolitis, including Paediatrician medical review

- Implement guidelines for the appropriate use of oxygen and antibiotics

- Develop consistent advice on safe home management for families

o Hip Fracture: Implement and embed LBVC approaches to meet the Australian Commission

on Safety and Quality in Health Care Hip Fracture Care Clinical Standards, with a particular

focus on activities outlined in the Clinical Improvement Activity Brief for the Hip Fracture

Care initiative including:

- Pain management assessments upon presentation

- Reduce time to surgery to less than 48 hours

- Early mobilisation and weight bearing

- Implementation of an orthogeriatric model of care

o Direct Access Colonoscopy for Positive Faecal Occult Blood Test (+FOBT)

- By December 2019 develop a plan for the implementation of direct access colonoscopy

for +FOBT across the district by June 2021

- Beginning in January 2020, implement Clinical Categorisation Guidelines for the booking

of colonoscopy waiting lists

- By December 2019, commence quarterly reporting on the number of colonoscopies

performed as a result of +FOBT.

30

- By June 2020, establish direct access for +FOBT referrals in at least one new public

colonoscopy facility in the district, including collaboration with the PHN to update health

pathways.

- By June 2020 be ready to commence quarterly reporting of wait times for colonoscopy in

public facilities by triage category and referral type and have a plan for ongoing quality

assurance of waitlists.

o Hypofractionated Radiotherapy for Early Stage Breast Cancer

- Regularly collect, provide, and report on key data items in alignment with the initiative’s

Monitoring and Evaluation Plan; providing quarterly and annual updates.

- By September 2019 perform a self-assessment of current hypofractionated radiotherapy

utilisation for the treatment of early stage breast cancer; identifying gaps in utilisation

- Participate in the co-design of a solution toolkit and implement local solutions and change

management plans to achieve optimal utilisation of hypofractionated radiotherapy.

o Wound Management

- Develop localised models of care, utilising statewide data and local diagnostics, to guide

the provision and delivery of services for wound management across the healthcare

system in line with the LBVC Standards for Wound Management.

Commissioning for Better Value

Commissioning for Better Value (CBV) is part of the statewide approach to deliver value based

healthcare across NSW Health. Commissioning is a process of considering the outcomes that

need to be achieved, and designing, implementing and managing a system to deliver these in the

most effective way. CBV reflects NSW Health’s commitment to refocus our services from volume

(outputs) to value (outcomes).

Outputs are designed around the amount of activity being provided. Outcomes are designed

around the person receiving the service. Outcomes are the difference the project can make to

improve the:

health outcomes that matter to patients

patient experience of receiving care

clinician experience of providing care

effectiveness and efficiency of care

Commissioning for better value is already being applied by some districts and networks in clinical

support and non-clinical service design, process improvements and procurement.

More information is available from http://internal.health.nsw.gov.au/vbhc/commissioning.html. The

main roles and responsibilities in the CBV program are:

Districts and Networks will use commissioning-based principles and tools to make clinical

support and non-clinical projects more impactful for patients, clinicians and other users.

The Ministry of Health will support the implementation of the NSW Government Commissioning

and Contestability Policy and develop guidance and tools to support Districts and Networks.

In 2019-20, Districts and Networks will apply a commissioning approach to non-clinical services by

considering the outcomes that need to be achieved.